Triamcinolone Acetonide

Indications

Triamcinolone Acetonide is used for: Allergic and inflammatory responses, Inflammatory joint disease, Inflammatory skin conditions

Adult Dose

Intramuscular Suppression of allergic and inflammatory disorders Adult: As acetonide: 20-80 mg via deep IM into gluteal muscles. Symptomatic control for hay fever Adult: As acetonide: 40-100 mg via deep IM into gluteal muscles. Rheumatic or arthritic disorders Adult: 60 mg IM every 6 weeks; may be supplemented by additional 20-100 mg IM PRN Intra-articular Inflammatory joint diseases Adult: As acetonide: Smaller joints: 2.5-5 mg (up to 10 mg), larger joints: 5-15 mg (up to 40 mg). Max: 20-80 mg/treatment. Intradermal Inflammatory skin conditions Adult: As acetonide: 1-3 mg/site. Max: 30 mg in total if several sites of inj used. Max: 12.5 mg/inj site. Max: 25 mg/lesion.

Child Dose

Intramuscular Suppression of allergic and inflammatory disorders Child: As acetonide: deep IM into gluteal muscle: initial 0.11 to 1.6 mg/kg/day in 3-4 divided doses. Do not use in premature infants and infants of low birth weight as it contains benzyl alcohol. Child: 6-12 years: 0.03-0.2 mg/kg IM every 1-7 days >12 years: 60 mg IM every 6 weeks; may be supplemented by additional 20-100 mg IM PRN >12 years, intralesional injection (10 mg/mL suspension): 1 mg per injection site 1 or more times weekly; not to exceed 30 mg/day Symptomatic control for hay fever Child: As acetonide: deep IM into gluteal muscle: initial 0.11 to 1.6 mg/kg/day in 3-4 divided doses. Do not use in premature infants and infants of low birth weight as it contains benzyl alcohol.

Renal Dose

Administration

Dilute with local anesthetic (1% or 2% lidocaine without parabens) before intra-articular or intralesional injection Dilute with D5/NS or D10/NS or NS or SWI before intralesional injection

Contra Indications

Triamcinolone Acetonide is contraindicated in patients with a sensitivity to the active or inactive ingredients. Untreated systemic fungal, bacterial, viral or parasitic infection, hypersensitivity. Neonates (Parenteral)

Precautions

Diabetes; hypertension, renal and liver impairment; glaucoma; psychosis; delayed tissue healing; cirrhosis; heart failure; recent MI; hypothyroidism; osteoporosis; peptic ulceration; thromboembolic disorders. Monitor height in children on prolonged therapy. Avoid rapid drug withdrawal. Elderly, children, pregnancy, lactation. Lactation: Excreted in breast milk; use caution

Pregnancy-Lactation

Interactions

Lowering of plasma salicylates levels. Increased risk of GI bleeding and ulceration with NSAIDs. Antagonised blood glucose-lowering effects of the antidiabetics. Increased risk of hyperkalaemia with amphotericin B, beta agonists, beta-blockers, potassium-depleting diuretics, theophylline. Increased clearance of the triamcinolone with ciclosporin, carbamazepine, phenytoin, barbiturate, rifampicin. Infections may develop if given with live vaccines.

Adverse Effects

Side effects of Triamcinolone Acetonide : HPA axis supression, intracranial hypertension, Cushing's syndrome, growth retardation in children; osteoporosis, fractures. Peptic ulceration; glaucoma; hyperglycaemia; GI upsets; increased appetite; increased fragility of skin; behavioural changes. Potentially Fatal: Acute adrenal insufficiency may be precipitated by infection or trauma in patients on long-term corticosteroid therapy or rapid withdrawal.

Mechanism of Action

Triamcinolone has mainly glucocorticoid activity. It suppresses the migration of polymorphonuclear leukocytes and reduces capillary permeability thereby decreasing inflammation.